Prognosis Christmas Baby - Amy Andrews Page 0,22
have time to moon over his blond good looks. She sat at the computer console furthest away from him, planning to review all the patients’ charts. She’d just clicked on the first one when Linda called her over to bed eight, where she was doing a meal relief.
‘I don’t like the look of her, Maggie.’
One look at Ruby Wallace and Maggie could understand Linda’s concern. She was tachycardic, hypotensive and febrile.
The little girl had been in a high-speed car accident two days ago. She’d been restrained but her head had still smashed sideways into the window, resulting in a large subdural haemorrhage. She’d had emergency neurosurgery to evacuate the blood but was still in a coma requiring ventilatory support.
‘She’s been grumbling along most of the day with this fever but just in the last twenty minutes she’s spiked her temp and her heart rate. Her oxygen requirement has increased. Her lactate on her blood gas is rising and her blood pressure’s bottoming out. I think she may be septic.’
Maggie nodded. ‘Nash?’ she called as she grabbed the Resus trolley again.
Nash wasn’t sure if it was because he was so attuned to her or whether it was the note of concern in Maggie’s voice but he stood immediately, joining her and Linda at bed eight. He listened to their concerns, more than a little alarmed at the deterioration in Ruby’s condition and the rising lactate.
‘Yes. I think she may be septic too. Let’s get some blood cultures and give her a ten per kilo bolus of colloid for her blood pressure to start with.’
Maggie accessed the arterial line for the blood while Linda hooked up the extra fluid.
‘Her abdo’s quite distended,’ Nash mused, palpating the tense dome. They’d been treating Ruby for an illeus since admission due to her lack of bowel sounds and bruising from the seat belt. Abdominal ultrasounds had shown no acute trauma but they’d kept her nil by mouth while her gut recovered from the impact.
‘Yes,’ Linda agreed, ‘I reckon it’s blown up just in the last hour.’
Maggie added the blood to the culture bottles, a heavy foreboding settling in her bones. She reached up to the monitor to adjust the alarm settings as Ruby’s heart rate climbed to one hundred and eighty. The little girl started to gag and cough and then vomited. Bilious liquid spilled from her mouth and nose, streaming down her face and over the sheets.
Maggie quickly whipped out the yankeur sucker and, turning Ruby’s head to the side to try to prevent aspiration, she suctioned the girl’s airway while Linda aspirated the nasogastric tube. Alarms trilled all around them as Ruby’s heart rate again breached the set limits.
‘I’ll call the surgical reg for a consult,’ Nash said, walking briskly to the nearest phone.
Maggie wiped Ruby’s face with a towel and used a couple more to sop up the excess stomach contents around her. Dr Hannah Oakland arrived fifteen minutes later as the second ten per kilo bolus was almost finished. Nash could see it was having no impact on the flagging blood pressure. ‘Let’s start some inotropes,’ he ordered.
Maggie and Kylie, Ruby’s nurse who had returned from her tea break, drew up some dopamine while Hannah and Nash consulted.
‘You want an ultrasound?’ Nash asked her
Hannah shook her head. ‘I think we need to go in and have a look. I’ll organise it. Where are her parents?’
‘Mother’s asleep in the parents’ lounge,’ Kylie volunteered.
Maggie, Nash, Linda and Kylie worked to stabilise Ruby for Theatre while Hannah talked to her tearful mother and gained consent for exploratory abdominal surgery. Maggie averted her eyes as Ruby’s mother stroked her daughter’s hair, tears trekking down her face.
‘It’s okay, Rube,’ she whispered, ‘you’re going to be okay.’
Even after fifteen years Maggie found it impossible not to become involved and she hoped desperately that Ruby’s mother was right and her gut feeling was wrong.
The sky was lightening when they finally wheeled Ruby into the operating theatre at the end of the corridor. Maggie and Linda, who hadn’t had a break yet, left Kylie to clean up the bed area confident that Ruby wouldn’t be back until the end of their shift, maybe even after that.
Nash joined them in the tearoom and they all sat round staring into their coffees still a little dazed by rapid-fire events of the night. Sure, these nights happened every now and then but they were both physically and emotionally draining.
Linda drained her mug and stood. ‘I’ll go check on Kylie,’ she said.
‘You haven’t